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Enhanced Syphilis Surveillance in Baltimore. Scott Tulloch Maryland State Department of Health and Mental Hygiene. Comprehensive Evaluation of the Syphilis Surveillance System. Over period of 1999-2000, the SEP performed evaluation of surveillance system following CDC guidelines
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Enhanced Syphilis Surveillance in Baltimore Scott Tulloch Maryland State Department of Health and Mental Hygiene
Comprehensive Evaluation of the Syphilis Surveillance System • Over period of 1999-2000, the SEP performed evaluation of surveillance system following CDC guidelines • 18 recommendations generated • Most have been implemented, others are in process of implementation
Elements of Enhanced Syphilis Surveillance in Baltimore • Expanded data collection (especially behavioral risks) • Enhanced syphilis interview • Jail Stat Lab project • Cross-jurisdictional data sharing • Expanded community screening
Behavioral Risk (Local Use) Variables • Collected on all syphilis cases as part of Original Patient Interview • Immediately indicates membership in suspected high prevalence networks • People who in engage in these behaviors are considered integral to spread of syphilis
Local Use Variables from InterviewsApr. 2001 – Jan. 2002 (n=120)
Congenital Syphilis Supplemental Data Collection • CDC 126 form can be limited for diagnosing CS risks • Designed supplemental data collection form to be used with CS investigations • Presently collect detailed data on: • Prenatal care during each trimester • If no prenatal care, reason(s) why • Drug screen information • Risk history of mother
Modified Interview: The Syphilis Assessment • Since December 2000, syphilis cases have been asked to identify locations where they met their sex partner(s) • Cases also report on risk behaviors occurring at these meeting places
Assessment Form -Focuses on where cases met their sex partners -Scanned into a database -Places and risks are mapped using GIS software
Stat Lab Project • Jail-based rapid disease intervention initiative • Prevalence monitoring of high-risk population • Partnering with local SE activities
Syphilis Reactor Prevalence (in%) At Baltimore City Jail By Sex and Quarter, 1998-2001
Percentage of Baltimore City P&S Syphilis Identified By Jail-Based Screening By Year (1999-2001)
Associated Risk Factors for P&S Syphilis Cases Identified by Jail-Based Screening (2001)
Cross-Jurisdictional Data Sharing • Assessment forms used by Baltimore are also used in surrounding counties, including jails. • Jail screening data (under jurisdiction of MD state), can now be shared for more complete syphilis histories
Enhanced Community Screening • “Piggyback” syphilis screening at sites where blood is being drawn for HIV test • Create leadership through funding key CBO partners • Partner with community clinics • Rapid Response Team outreach screening
Conclusion • Creating an effective “tool” • Multi-pronged approached • Representative • Data supported interventions • Community Involvement • Community • Community • Community